Proximal guidewire port

ABSTRACT

Methods and devices incorporating a guidewire entry port subassembly for use in rapid exchange catheters. The use of a subassembly allows for stronger quality control and simpler fabrication of a rapid exchange device. In several embodiments, methods of making a molded guidewire entry port using a mold, often in conjunction with one or more mandrels, are disclosed. Several device embodiments include a separate molded guidewire port as well as molded guidewire ports which are attached, during a molding step, to segments of a catheter.

FIELD OF THE INVENTION

The present invention is related to medical devices, more particularlyto elongate medical devices such as catheters. In particular, thepresent invention is related to catheters which have a distal guidewireport.

BACKGROUND OF THE INVENTION

Single-operator-exchange (SOE) or “monorail” catheters are catheters inwhich only a distal portion of the catheter tracks over a guidewire.Proximal of the distal portion that tracks the guidewire, an SOEcatheter and guidewire are separate from one another. This allows theproximal portion of the SOE catheter to be relatively simple, havingneed of one less lumen than would be required for an over-the-wirecatheter that tracks a guidewire over its entire length. An SOE catheteris also useful because, by not tracking the guidewire over its entirelength, the catheter and guidewire are more easily moved relative oneanother, such as during a catheter exchange. One example of an earlypatent in this area is U.S. Pat. No. 5,156,594 to Keith, the disclosureof which is incorporated by reference.

A drawback for SOE catheters is the difficulty of fabrication.Construction of an SOE device typically involves welding or fusingseveral lengths of tubing together such that a distal portion of the SOEdevice includes an additional lumen for receiving a guidewire. Aguidewire opening or port is provided to allow a guidewire to beintroduced to the guidewire lumen through the guidewire port. A numberof different manners for providing the guidewire port joint to a rapidexchange-type of medical device have been suggested, for example, byFitzmaurice et al., U.S. Pat. No. 6,190,358; Enger, U.S. Pat. No.5,980,486; Estrada et al., U.S. Pat. No. 6,344,029, and Williams et al.,U.S. Pat. No. 6,409,863. Williams et al. is also hereby incorporated byreference. The disclosure of the Keith patent above, incorporated byreference, discloses a crimped hypotube which is then attached to adistal polymer member having a guidewire tube and an outer tube aroundthe guidewire tube.

The steps of preparing (including, for example, crimping, trimming orcutting), placing and fusing the tubular members in proper alignment arelabor intensive, creating costs in terms of labor, time and qualityassurance. This is particularly so given the small size of the variouspieces of the final SOE product.

SUMMARY OF THE INVENTION

The present invention provides a number of methods for providingguidewire port subassembly for use in a catheter, as well as a number ofpieces for using in assembling a catheter. A number of combinations areprovided in a number of embodiments, where none or one or more of theproximal, distal guidewire or distal outer tubular members may be fusedto the port subassembly during fabrication of the port subassembly.

A first embodiment includes a method of making a catheter comprisingproviding a port joint for coupling a proximal member to one or moredistal members, the port joint adapted to couple a lumen in the proximalmember to a lumen defined by the distal member(s). For the illustrativemethod, port joint includes a guidewire port for receiving a guidewireand a guidewire lumen for coupling the guidewire into a lumen defined bysaid distal member(s).

In several embodiments, a method of providing a port joint subassemblyfor a rapid exchange catheter is provided. The method includes molding aport joint subassembly for joining a proximal member having a firstlumen to a distal member having a second lumen and a distal guide memberhaving a guidewire lumen, the port joint subassembly adapted to couplethe first lumen to the second lumen and including a guidewire port fordirecting a guidewire from outside the catheter into the guidewirelumen. In several illustrative embodiments, the port joint subassemblymay be attached to one or more of the proximal member, the distal memberor the distal guide member during fabrication. The attachment may beaccomplished by providing a portion of one or more of the proximalmember, the distal member or the distal guide members inside a mold usedto shape the port joint subassembly in an injection molding process. Infurther embodiments, the port joint subassembly may be provided withstructures adapted to receive or attach to the proximal member, thedistal member or the distal guide member.

One embodiment comprises a port joint subassembly adapted to couple to aproximal member and two distal members. Several embodiments encompassdevices including molded port joint subassemblies. In one suchembodiment, the device includes a proximal member for providing aninflation fluid which is attached to a port joint subassembly by moldingthe port joint with over the proximal member to create an attachmentbetween the two. The proximal member may be inserted to a mold forshaping the port joint subassembly and some portion of the port jointsubassembly molded around the proximal member. The proximal member mayalso be inserted to a mold for shaping the port joint subassembly andsome portion of the port joint subassembly allowed to flow into theproximal member to create attachment from the interior of the proximalmember. A combination of inner and outer attachment may also be providedas desired. Additional embodiments include provision of a distal guidemember and distal member in like fashion as that just explained withrespect to the proximal member.

Further embodiments include methods for providing strain relief across aport joint subassembly by molding the port joint subassembly andproviding for attachment to a strain relief member such as a core wire,a coil, or a spiral cut portion of a hypotube, or any other strainrelief structure. The attachment may be provided adhesively, or thechosen strain relief structure may be provided using a specially shapedmold for the port joint subassembly. In another embodiment, the strainrelief member may be placed at least partly within a mold for making theport joint subassembly such that attachment is achieved during a moldingstep.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a cross-sectional view of a prior art distal guidewire port;

FIG. 2 is a partial cut-away perspective view of a distal guidewire portin accordance with an illustrative embodiment of the present invention;

FIGS. 3A-3D are cross-sectional views showing steps of an illustrativeembodiment including a distal inner section attached during a moldingstep;

FIGS. 4A-4D are cross-sectional views showing steps of an illustrativeembodiment including a distal outer section attached during a moldingstep;

FIGS. 5A-5D are cross-sectional views showing steps of an illustrativeembodiment including each of the distal outer and distal inner sections,as well as the proximal member, being attached during a molding step;and

FIGS. 6A-6D are cross-sectional views showing steps of an illustrativeembodiment including the proximal member attached during a molding step.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following detailed description should be read with reference to thedrawings. The drawings, which are not necessarily to scale, depictillustrative embodiments and are not intended to limit the scope of theinvention. Throughout the following description, a number of molds aredescribed. The molds may be made of any suitable material and may beprovided with any of a variety of known coatings for aiding in a moldingprocess. Further, while not shown, the molds can include any of theknown types of injection ports allowing for injecting a molding materialas well as any desired venting ports. Single or multiple infusion/ventports may be used in a single mold, and the mold may be fabricated byany of a number of known processes with a wide variety of materials,without altering the inventive concepts described herein.

FIG. 1 is a cross-sectional view of a prior art distal guidewire port. Asimilar port is illustrated in U.S. Pat. No. 5,156,594. The sectionalview shows a midshaft region where a proximal member 10 is joined to adistal member 12 across a port joint 14. The distal member 12 includesan outer member 16 and an inner member 18. The outer member 16 defines agenerally annular lumen around the inner member 18. The outer member 16may couple to an inflatable member 20. The port joint 14 includes amidshaft member 22 having a proximal end 22 a and a distal end 22 b.

The midshaft member 22 is disposed so that, at its proximal end 22 a, itis generally circular and surrounds and is attached to the proximalmember 10. At the distal end 22 b, the midshaft member 22 takes on acrescent shape, partially surrounding the inner member 18 on one side,with the outer member 16 surrounding both the midshaft member 22 and theinner member 18. It is readily observed that forming the joint 24 at thedistal end 22 b of the midshaft member 22 can be time consuming andlabor intensive.

During this process, of course, care must be taken to form a suitableentry 26 for a guidewire to pass into the guidewire lumen 28 defined bythe inner member 18. Additional care must also be taken to preserve theintegrity, and keep open, the inflation lumen 30 which passes from theinterior of the proximal member 10 to the midshaft member 22 and intothe outer member 16 of the distal member 12. Difficulty can arise due tothe use of a tubular midshaft member 22 between the proximal member 10and the distal member 12, as the midshaft member 22 must be carefullyshaped and held in place.

FIG. 2 is a partial cut-away perspective view of a distal guidewire portin accordance with an illustrative embodiment of the present invention.A midshaft portion 40 of an assembled rapid exchange catheter isillustrated, including a proximal member 42 coupled to a port joint 44,which in turn couples to a distal outer member or shaft 46 and a distalinner member or shaft 48. The port joint 44 of the illustrativeembodiment is constructed by use of a molding process.

The port joint 44 is shaped to include several features. A passageway 50provides an inflation lumen connecting a first inflation lumen 52defined by the proximal member 42 with a second inflation lumen 54defined between the distal outer shaft 46 and the distal inner shaft 48.An opening 56 allows access to a guidewire passage 58 that connects tothe guidewire lumen 62 of the distal inner shaft 48. A ramped portion 60allows for a relatively smooth entry for the guidewire into theguidewire passage 58.

One or more of the proximal member 42, distal outer shaft 46 and distalinner shaft 48 may be attached to the port joint 44 during fabricationof the port joint 44 itself For example, the proximal member 42 may beinserted into a mold used to make the port joint 44 prior to injectingmolding material, and, due to the heat and other effects of the process,the port joint 44 and proximal member 42 can become affixed to oneanother as the injected material cools. In another example, the distalouter member 46 may be partially inserted into a mold used to make theport joint 44 prior to injection, and again, the distal outer member 46and the port joint 44 can become affixed to one another as the injectedmaterial cools. Likewise, the distal inner member 48 may be partiallyinserted into a mold used to make the port joint 44 prior to injection,and the distal inner member 48 can become affixed to the port joint 44as the injected material cools.

In further embodiments, more than one of the proximal member 42, distalouter shaft 46, or distal inner shaft 48 may be affixed to the portjoint 44 in similar fashion during a molding step. In one suchembodiment, the heat occurring during the molding step can cause thedistal outer member 46 and distal inner member 48 to become affixed toone another, providing additional strength to the midshaft portion 40,particularly where the proximal member 42 is stiffer than either distalmember 46, 48. In other embodiments a butt joint, rather than the lapjoints illustrated, may be used.

Alternatively, a port joint may be fabricated independently. Forexample, an injection molding process, where molten injectate materialis infused into a mold, may be used. Alternatively, the port joint maybe machined by taking a piece of material (i.e. a polymer) and drillingholes and grinding the exterior to achieve the desired shape andconfiguration of lumens and member receiving locations.

Any suitable material, such as a polymer, may be used for constructingthe port joint 44. Some suitable polymers and coatings include thefollowing polymers and copolymers: polycarboxylic acid polymers andcopolymers including polyacrylic acids (e.g., acrylic latex dispersionsand various polyacrylic acid products; acetal polymers and copolymers;acrylate and methacrylate polymers and copolymers; cellulosic polymersand copolymers, including cellulose acetates, cellulose nitrates,cellulose propionates, cellulose acetate butyrates, cellophanes, rayons,rayon triacetates, and cellulose ethers such as carboxymethyl cellulosesand hydoxyalkyl celluloses; polyoxymethylene polymers and copolymers;polyimide polymers and copolymers such as polyether block imides,polybismaleinimides, polyamidimides, polyesterimides, andpolyetherimides; polysulfone polymers and copolymers includingpolyarylsulfones and polyethersulfones; polyamide polymers andcopolymers including nylon 6,6, polycaprolactams and polyacrylamides;resins including alkyd resins, phenolic resins, urea resins, melamineresins, epoxy resins, allyl resins and epoxide resins; polycarbonates;polyacrylonitriles; polyvinylpyrrolidones (cross-linked and otherwise);anhydride polymers and copolymers including maleic anhydride polymers;polymers and copolymers of vinyl monomers including polyvinyl alcohols,polyvinyl halides such as polyvinyl chlorides, ethylene-vinylacetatecopolymers (EVA), polyvinylidene chlorides, polyvinyl ethers such aspolyvinyl methyl ethers, polystyrenes, styrene-butadiene copolymers,acrylonitrile-styrene copolymers, acrylonitrile-butadiene-styrenecopolymers, styrene-butadiene-styrene copolymers andstyrene-isobutylene-styrene copolymers, polyvinyl ketones,polyvinylcarbazoles, and polyvinyl esters such as polyvinyl acetates;polybenzimidazoles; ionomers; polyalkyl oxide polymers and copolymersincluding polyethylene oxides (PEO); glycosaminoglycans; polyestersincluding polyethylene terephthalates and aliphatic polyesters such aspolymers and copolymers of lactide (which includes lactic acid as wellas d-, 1- and meso lactide), epsilon-caprolactone, glycolide (includingglycolic acid), hydroxybutyrate, hydroxyvalerate, para-dioxanone,trimethylene carbonate (and its alkyl derivatives), 1,4-dioxepan-2-one,1,5-dioxepan-2-one, and 6,6-dimethyl-1,4-dioxan-2-one (a copolymer ofpolylactic acid and polycaprolactone is one specific example); polyetherpolymers and copolymers including polyarylethers such as polyphenyleneethers, polyether ketones, polyether ether ketones; polyphenylenesulfides; polyisocyanates (e.g., U.S. Pat. No. 5,091,205 describesmedical devices coated with one or more polyisocyanates such that thedevices become instantly lubricious when exposed to body fluids);polyolefin polymers and copolymers, including polyalkylenes such aspolypropylenes, polyethylenes (low and high density, low and highmolecular weight), polybutylenes (such as polybut-1-ene andpolyisobutylene), poly-4-methyl-pen-1-enes, ethylene-alpha-olefincopolymers, ethylene-methyl methacrylate copolymers and ethylene-vinylacetate copolymers; fluorinated polymers and copolymers, includingpolytetrafluoroethylenes (PTFE),poly(tetrafluoroethylene-co-hexafluoropr-opene) (FEP), modifiedethylene-tetrafluoroethylene copolymers (ETFE), and polyvinylidenefluorides (PVDF); silicone polymers and copolymers; polyurethanes (e.g.,BAYHYDROL polyurethane dispersions); p-xylylene polymers;polyiminocarbonates; copoly(ether-esters) such as polyethyleneoxide-polylactic acid copolymers; polyphosphazines; polyalkyleneoxalates; polyoxaamides and polyoxaesters (including those containingamines and/or amido groups); polyorthoesters; biopolymers, such aspolypeptides, proteins, polysaccharides and fatty acids (and estersthereof), including fibrin, fibrinogen, collagen, elastin, chitosan,gelatin, starch, glycosaminoglycans such as hyaluronic acid; as well asblends and copolymers of the same.

Several embodiments make use of polyether block amides (PEBAX) for theport joint 44. Some illustrative factors to consider in selecting asuitable material for the port joint 44 include consideration of thecompatibility with the materials of the adjacent tubular members (i.e.,the proximal member 42, the distal outer member 46 and the distal innermember 48) as well as final product properties such as tensile strength,pushability, lubricity and flexibility. The material may be chosen toprovide a transition in flexibility or other characteristics between theproximal member 42 and the distal members 46, 48. In some embodiments,additional features may be used to provide enhanced or differentproperties including, for example, the provision of a core wire that maybe placed through the port joint during the fabrication process toimprove strain relief or pushability, or a heat shrink member that maybe placed about the port joint to improve lubricity or tensile strength.Coatings or other treatments may also be applied.

Several of the following embodiments illustrate methods for providing adistal port subassembly or transition section. Included are embodimentsillustrating attaching a proximal member or either distal member to aport joint during a molding step, as well as an embodiment where each ofthe proximal member and both distal members are attached simultaneouslyduring a molding step. Various combinations of these attachmenttechniques may also be used.

FIGS. 3A-3D are cross-sectional views showing steps for use of anillustrative embodiment including a distal inner section attached duringa molding step. FIG. 3A illustrates two specialized parts for theprocess. A mold 80 is shown in cross section. The mold 80 defines avolume 82 having a number of openings including a distal guide opening84, a distal inflation opening 86, a proximal mandrel opening 88, and aproximal inflation opening 90. Also used is a guide path mandrel 92having a somewhat curved distal end having a lesser diameter.

FIG. 3B illustrates a pre-mold configuration for the mold 80 having theguide path mandrel 92 inserted. Prior to insertion of the guide pathmandrel 92, the narrow end of the guide path mandrel 92 was loaded ontothe proximal end of the distal inner member 94. This combination isloaded into the mold 80 such that the guide path mandrel 92 extends fromthe proximal mandrel opening 88 and the distal inner member 94 extendsfrom the distal guide opening 84. An inflation mandrel 96 (so named hereto indicate it maintains an inflation lumen opening) is placed to passthrough the distal inflation opening 86 and the proximal inflationopening 90. While FIG. 3B is a cross-sectional view, it should beunderstood that the volume 82 extends around the mandrels 92, 96 and thedistal inner member 94 to create a three-dimensional space for injectinga molding material. Once configured as in FIG. 3B, an molding materialis injected to the volume 82 by any suitable process.

After the molding step, the mold and mandrels are removed to leave anapparatus or catheter sub-assembly as illustrated in cross section inFIG. 3C having the distal inner member 94 and a port joint subassembly96 attached together. Selection of compatible materials for the distalinner member 94 and the port joint subassembly 96 will result inattachment of the port joint subassembly 96 to the distal inner member94 during the molding step.

Because of the shape of the mold, the port joint subassembly 96 includesseveral locations adapted for attachment to other catheter parts. Thisincludes a distal attachment location 98 which may be a collar orsmoothed region sized to receive a distal outer member (not shown). Thedistal attachment location 98 may also include a ridge such that it canslidably receive a distal outer member (not shown) up to a controlledlocation, assuring repeatable engagement of a distal outer member (notshown) to the distal attachment location 98.

A proximal attachment location 100 is also illustrated. The proximalattachment location 100 may be adapted in to allow for engagement of aproximal member (not shown) and may include features similar to those ofthe distal attachment location 100. Either attachment location may alsobe provided with mechanical attachment features such as, for example, alocking collar having a ridge, threading, barbs or other mechanicalfeatures.

The guide path mandrel 92 (FIG. 3B) is removed to leave a guidewireentry port 102 including a smoothed entry location 104. The guide wireentry port 102 leads into the lumen defined by the distal inner member94. The combination of the guide wire entry port 102, smoothed entrylocation 104 and inner member 94 create a guidewire entry path. By usingthe fabrication methods illustrated herein, the guidewire entry path ofFIG. 3C can be shaped as desired, without requiring special treatment(i.e., slitting, skiving or the like) of a tubular member. This allowsfor improved entry path features and reduced production costs. Ifdesired, the guidewire entry port 102 may be machined for furtherdefinition of the entry path. The inflation mandrel 96 (FIG. 3B) isremoved to leave an inflation lumen 106 which is designed to allowinflation fluid (and hence inflation pressure) to pass from a proximalmember to a distal member.

FIG. 3D illustrates in cross section a port joint incorporating thedevice of FIG. 3C. In particular, a distal outer member 108 has beenprovided in a location to correspond to the distal attachment location98. In one embodiment the distal outer member 108 is attached at theattachment location by the use of either a hot jaw or a laser bondingprocess, either of which creates localized heating, melting andattachment. In other embodiments an adhesive, mechanical lock or anyother suitable process may be used to attach the distal outer member.Also, a proximal member 110 is attached at the proximal attachmentlocation 100. Again, the attachment may be by the use of localizedheating, adhesive, mechanical or any other suitable process. Furtherembodiments may also include various strain relief members placed acrossor incorporated into the port joint, including a spiral cut hypotube, acoil member, or the like.

FIGS. 4A-4D are cross-sectional views showing steps of an illustrativeembodiment including a distal outer section attached during a moldingstep. FIG. 4A illustrates a configuration in a pre-molding step. A mold120 is provided with a guide path mandrel 122, a proximal cap 124, andan inflation mandrel 126. The guide path mandrel 122 and inflationmandrel 126 may include mechanisms for securing to the mold 120 andproximal cap 124, respectively. The proximal cap 124 is removablysecured to the mold 120.

A distal outer member 128 is shown partially inserted into the mold 120.Though not shown, the mold 120 may include a stop or other feature forpreventing the distal outer member 128 from being passed too far intothe mold. An injection stop 130 is also illustrated, the injection stop130 having been placed over the distal ends of the mandrels 122, 126.The injection stop 130 may be placed first and the distal outer member128 slid thereover, or the injection stop may be loaded into the distalouter member 128 and then loaded over the mandrels 122, 126.

In one embodiment, the injection stop 130 is sized to match the desiredlength of the distal outer member 128, and one of the mandrels 122, 126may include a taper or other feature such that the injection stop 130may only pass a certain distance over whichever mandrel 122, 126 is sodesigned. Thus, by observing the distal end of the distal outer member128 with respect to the distal end of the injection stop 130, one mayachieve a repeatable placement of the distal outer member 128 withrespect to the mold 120. The distal outer member 128 may also beconstructed of a transparent material to facilitate observation of thepositioning of the injection stop 130. The injection stop 130 aids incontainment of the injectate material (which is typically in aliquid-like form) to a space 132 defined by the mold 120 and cap 124,the mandrels 122, 126, and the distal outer member 128.

After the configuration of FIG. 4A is achieved, a suitable material isinjected to the mold 120 and allowed to cool/solidify to form a shapedmember 134 in the space 132, as shown in FIG. 4B. The injection stop 130(FIG. 4A) is then removed. A distal inner member 136 is passed over theguide path mandrel 122 until it reaches an attachment location 138adjacent the member 134. The distal inner member 136, at least near itsproximal end (the end illustrated on FIG. 4B), is then attached alongthe attachment location 138 to at least one of the distal outer member128 or the member 134. Such attachment may be achieved by any of anumber of methods including, for example, the application of localizedheating (i.e., a hot jaw, laser bonding, or welding process) at theattachment location 138. Any suitable heating, mechanical or adhesiveprocess may also be used.

In one embodiment, the guide path mandrel 122 may be a member includinga lumen at least partially therethrough, with an opening at a locationcorresponding to the proximal end of the distal inner member 136, and anadhesive may be infused through the guide path mandrel 122 to theattachment location 138 for attaching the distal inner member 136.Although the device illustrated shows the distal inner member 136shifted to one side of the distal outer member 128, more distal portionsmay allow the distal inner member 136 to be centered, or may maintainthe distal inner member 136 to one side.

The mold 120 and proximal cap 124 may be removed before or after thedistal inner member 136 is attached. In several embodiments the guidepath mandrel 122 may remain in place to maintain a desirable, smoothguide path entry during heating used in some embodiments to attach thedistal inner member 136. After attachment of the distal inner member136, the guide path mandrel 122 may be removed, opening the guidewireentry port 140 of the member 134, the shape of which is generallycontrolled by the shape of the guide path mandrel 122. The inflationmandrel 126 may remain in place as a proximal member 142 is placed toengage a proximal attachment location 144. The proximal member 142 is,in an illustrative embodiment, attached at the proximal attachmentlocation 144 by the application of localized heat. In other embodiments,the proximal attachment location 144 may include mechanical features forattaching the proximal member 142, or an adhesive may be applied. Ifheat is used, the guide path mandrel 122 and/or the inflation mandrel126 may remain in place to maintain the patency of the lumens defined byeach against the applied heat.

FIG. 4D illustrates a completed joint, with the inflation mandrelremoved to illustrate an inflation lumen 146 defined by the member 134.The inflation lumen 146 connects a lumen defined by the proximal member142 to a lumen defined between the distal outer member 128 and thedistal inner member 136. It should be noted that in contrast to theillustrative embodiment of FIGS. 3A-3D, the illustrative embodiment ofFIG. 4D has a relatively constant diameter across the port joint. Eitherform may be achieved with the present invention.

In the illustrative embodiment of FIGS. 4A-4D, the inflation mandrel 126is loaded through the distal outer member 128. This may improve ease offabrication, since the inflation mandrel 126 would need to be only a fewcentimeters longer than the distal outer member 128, which is typicallyrelatively short in comparison with the proximal member 142. To allowfor a relatively short inflation mandrel 126, the injection stop 130 maybe provided with a slit along a side thereof allowing the inflationmandrel 126 to be held in place at a distal end while the injection stop130 is removed and peeled off of the inflation mandrel 126.

FIGS. 5A-5D are cross-sectional views showing steps of an illustrativeembodiment including each of the distal outer and distal inner sections,as well as the proximal member, being attached during a molding step. Amold 160 includes a proximal guide opening 162, a proximal inflationopening 164, and a distal opening 168, and defines a space 170. A distalouter member 172 is inserted partially into the mold 160. The distanceof insertion may be controlled mechanically if desired, while in atleast one embodiment a visible marker may be supplied on the distalouter member 172 to indicate proper insertion.

FIG. 5B illustrates a next step in the preparation of the mold 160. Adistal inner member 174 is illustrated as including a guide mandrel 176loaded at least partially therein, passing through the space 170 and outof the mold 160. The guide mandrel 176 may be sized to fittingly slideinto the distal end of the distal inner member 174 and may be tapered toallow easy removal. The guide mandrel 176 need not be full length withrespect to the distal inner member, and may, in fact, be substantiallyshorter as further explained below. As placed, the guide mandrel 176extends out of the proximal guide opening 162.

Next, as shown in FIG. 5C, a proximal member 178 is partially insertedto the mold 160 in a fashion similar to that of the distal outer member172. The proximal member 178 is also pre-loaded with an inflationmandrel 180, although in an alternative embodiment, the inflationmandrel 182 may be pre-loaded to the distal outer member 172 and thedistal end of the proximal member 178 loaded thereon. The inflationmandrel 180 passes through the space 170 and the mold 160, and includesa taper 182 to allow easy passage into space between the distal outermember 172 and the distal inner member 174. The space 170 is shaped tocreate a space outside of each of the inserted members 172, 174, 178,which will allow molding material to pass around the inserted members172, 174, 178, creating attachment thereto.

FIG. 5D is a cross section illustrating the structure formed aftermolding is performed with the configuration shown in FIG. 5C to create amember 184. The mold 160 (FIG. 5C) and mandrels 176, 182 (FIG. 5C) havebeen removed. As illustrated, the distal outer member 172 is nowattached to the member 184 at a first outer location 186 and a secondouter location 188, where the member 184 surrounds a portion of thedistal outer member 172. Any ridges at these locations may be smoothedby, for example, grinding, provision of a shrink tube, or by a heatingstep that results in minor plastic re-flow.

The distal inner member 174 is attached to the member 184 at an outerlocation 190 as well as along an inner extension 192. The inflationmandrel (not shown) may be specially shaped to encourage creation of anattachment along an inner extension 192. The proximal member 178 is alsoattached along a location 194. Again, any flare or edges created atthese attachment locations may be smoothed by any appropriate steps,including grinding, laser removal or localized re-melt.

A guidewire entry port 196 is created and leads into the distal innermember 174. The actual shape and any other characteristics of theguidewire entry port 196 are readily adjusted and controlled by shapingof the guide mandrel (not shown) and the distal guide port (not shown)of the mold (not shown). The distal inner member 174 is illustrated asbeing at an angle with respect to the distal outer member 172, which mayallow for a coaxial distal section defining an annular inflation lumen.The angle may also create an easy passage for a guidewire to traversewith little friction.

The member 184 also defines an inflation lumen 198 which fluidlyconnects a lumen defined by the proximal member 178 to a lumen definedbetween the distal inner member 174 and the distal outer member 172. Theinflation lumen 198 may be of any chosen shape, as controlled by theshape of the inflation mandrel.

As noted, the process illustrated in FIGS. 5A-5D allows the molding stepto create an attachment to each of the proximal member 178 and bothdistal members 172, 174. This may allow for a simpler fabricationprocess or may create more consistent bonds among the several elementsof the final design. Such fabrication processes, where an injectatematerial is injected such that it contacts another part of the finalproduct are sometimes referred to as insert molding processes.

FIGS. 6A-6D are cross-sectional views showing steps of an illustrativeembodiment including the proximal member attached during a molding step.FIG. 6A illustrates a configuration prepared for a molding step. A mold200 is provided with a guide mandrel 202 which may be attached thereto.A proximal opening 204 of the mold 200 has a portion of a proximalmember 206 inserted therein. An inflation mandrel 208 extends within theproximal member 206 and has a specially formed distal end. A core wire210, which may be tapered as shown or may have a cylindrical, stepped orother shape, is placed to extend from a location proximal of the areashown to a location distal of the area shown. For example, the core wire210 may be attached to the proximal member 206 using an adhesive or by aspot weld (if, for example, the proximal member 206 is a hypotube).Also, if a hub is provided on the proximal member 206, the core wire 210may be snap fit to or into the hub. The core wire 210 passes through avolume 212 where a molding material will be infused. The mold 200includes distal openings for receiving the guide mandrel 202, inflationmandrel 208 and core wire 210.

FIG. 6B illustrates a device as fabricated by injecting a material inthe mold 200 of FIG. 6A. As illustrated, the mold 200 has been removed.The member 214 is shown having the guide mandrel 202 passing through afirst portion, as well as being attached to the proximal member 206 andsurrounding in part the core wire 210. During the molding process, thecore wire 210 may or may not become securely attached (i.e., adhered to)the member 214, depending on the materials used for both pieces and anyintervening coatings or other factors. The inflation mandrel 208 is alsoshown remaining in place.

Once the configuration shown in FIG. 6B is achieved (and, if desired,the injected material is properly cooled), additional parts may be addedif desired, as shown in FIG. 6C. In particular, a distal outer member216 is placed over a portion of the member 214, while a distal innermember 218 is placed about the tip of the guide mandrel 202. The guidemandrel 202 may be left in place for the purpose of guiding the distalinner member 218 to the proper alignment and location as shown. With thedistal outer member 216 and distal inner member 218 placed, a localizedheating process may be used to create attachment with the member 214 andbetween the two distal members 216, 218. Alternatively, an adhesive ormechanical structure may be used to create an attachment.

FIG. 6D illustrates the completed distal guidewire port, with themandrels 202, 208 of FIG. 6C removed. The removal of the inflationmandrel 208 opens an inflation lumen 220 that fluidly connects a lumenin the proximal member 206 to the lumen defined between the distal outermember 216 and the distal inner member 218. The core wire 210 is partlyembedded into the member 214, and provides a transition in flexibilityand strength from the proximal member 206 across the port joint to thedistal members 216, 218. The core wire 210 may be included in similarform in any of the embodiments disclosed herein as an optionalstrain-relief apparatus.

After the steps illustrated above, and once the devices illustrated inFIGS. 3D, 4D, 5D, and 6D are fabricated, additional steps may beperformed to complete the catheter device. In some embodiments theproximal members illustrated may be attached after a proximal hub and/ormanifold is provided thereon. In other embodiments, the proximal membersmay be attached to additional proximal members to reach the proximalend, or a hub or manifold may be directly provided on the proximalmembers. Additional coatings may also be applied. The distal members, inseveral embodiments, are provided with a balloon. In one suchembodiment, a balloon is attached by any suitable process in a mannersuch that the balloon has a proximal end attached to the distal outermember and a distal end attached to the distal inner member, and theinflation lumen opens into the balloon.

In further embodiments, multi-lumen proximal or distal members may beused. In several such embodiments, a distal member is used having morelumens than a proximal member. Further, while the Figures illustrate theuse of a single lumen proximal section with a dual lumen distal section,other embodiments can include the provision of a dual lumen proximal andtriple lumen distal, or any other combination.

Some embodiments include a guidewire path mandrel permanently affixed toa side of the mold, shaped for providing the guidewire entry port, withthe mandrel having a distally extending tapered portion which begins ata diameter that is greater than the inner diameter of the distal innermember and ends at a diameter which is less than the inner diameter ofthe distal inner member, such that the distal inner member may slideover part of the mandrel but can only slide a certain distance up themandrel. One such embodiment is shown in FIGS. 3A-3D. This allows aneasily repeatable fabrication process, since the distal inner memberwill repeatably slide to the same location on the mandrel. The mandrelmay include a ridge or other defined line instead of a smooth taper inanother embodiment. The mold may include a mechanism such as a cinchscrew, or other elastic or resilient mechanism for holding the distal orproximal members in place once it is advanced to a desired location inthe mold. The mandrels may also include one or more mechanisms such as ahook or other device which may protrude from a distal portion of thetaper to “catch” the inner wall of the distal inner member.

For the purposes of disclosure, several of the mandrels illustratedherein are shown as generally cylindrical. In several embodiments,various non-cylindrical mandrels may be used including, for example,flattened or crescent-shaped mandrels. In several embodiments, acrescent-shaped mandrel having a flattened end is used to extend throughthe proximal member into the port joint. The flattened end can be shapedto partially curve around and receive the distal inner member fromwithin the distal outer member. When a crescent-shaped mandrel is used,the inflation lumen may have a circular profile within the proximalmember, transition to a crescent-shaped lumen through the port joint,and again transition to an annular lumen distal of the port joint.

Those skilled in the art will recognize that the present invention maybe manifested in a variety of forms other than the specific embodimentsdescribed and contemplated herein. Accordingly, departures in form anddetail may be made without departing from the scope and spirit of thepresent invention as described in the appended claims.

1. A method of making a catheter, the catheter including a proximalmember defining a first lumen and a distal member defining a secondlumen and a guidewire lumen, the method comprising: providing a mold;injecting molding material into the mold to mold a port joint having aproximal portion and a distal portion from the molding material, themolding material forming the port joint being discrete from material ofthe proximal member and material of the distal member; joining theproximal member to the distal member with the port joint such that theproximal member is longitudinally spaced from the distal member by theport joint, the port joint adapted to couple the first lumen to thesecond lumen and including a guidewire port for directing a guidewirefrom outside the catheter into the guidewire lumen; wherein: the distalmember includes a first tubular member and a second tubular member; andthe method further comprises the step of coupling the first tubularmember to the mold such that, when the port joint is molded, the firsttubular member becomes attached to the port joint, and the distalportion of the port joint is at least partially disposed within thefirst tubular member.
 2. The method of claim 1, wherein the step ofcoupling the first tubular member to the mold includes passing a portionof the first tubular member over a mandrel.
 3. The method of claim 2,wherein the mandrel extends from the mold prior to passing the firsttubular member thereover.
 4. The method of claim 2, wherein the methodincludes coupling the mandrel to the mold after passing a portion of thefirst tubular member over a portion of the mandrel.
 5. The method ofclaim 2, further comprising the step of coupling the proximal member tothe mold such that, when the port joint is molded, the proximal memberbecomes attached to the port joint.
 6. The method of claim 5, whereinthe step of coupling the proximal member to the mold includes the stepof passing a portion of the proximal member over a portion of themandrel.
 7. A method of making a catheter, the catheter including aproximal member defining a first lumen and a distal member defining asecond lumen and a guidewire lumen, the method comprising: providing amold; injecting molding material into the mold to mold a port jointhaving a proximal portion and a distal portion from the moldingmaterial, the molding material forming the port joint being discretefrom material of the proximal member and material of the distal member;joining the proximal member to the distal member with the port jointsuch that the proximal member is longitudinally spaced from the distalmember by the port joint, the port joint adapted to couple the firstlumen to the second lumen and including a guidewire port for directing aguidewire from outside the catheter into the guidewire lumen; wherein:the distal member includes a first tubular member and a second tubularmember; and the method further comprises the step of coupling the secondtubular member to the mold such that, when the port joint is molded, thesecond tubular member becomes attached to the port joint, and the distalportion of the port joint is at least partially disposed within thesecond tubular member.
 8. The method of claim 7, wherein the step ofcoupling the second tubular member to the mold includes the step ofpassing a portion of the second tubular member over a mandrel.
 9. Themethod of claim 8, wherein the mold includes the mandrel extendingtherefrom.
 10. The method of claim 8, wherein the step of coupling thesecond tubular member to the mold includes the step of coupling themandrel to the mold after passing the second tubular member over aportion thereof.
 11. A method of making a rapid exchange type catheter,the catheter including a proximal member defining a first inflationlumen, a distal outer member defining a second inflation lumen, and adistal inner member defining a guidewire lumen, the method comprising:providing a mold; injecting molding material into the mold to mold aport joint from the molding material, the molding material forming theport joint being discrete from material of each of the proximal member,the distal outer member and the distal inner member; joining theproximal member to the distal outer member and the distal inner memberwith the port joint such that the proximal member is longitudinallyspaced from the distal outer member and the distal inner member by theport joint, the port joint adapted to fluidly couple the first inflationlumen to the second inflation lumen and including a guidewire port fordirecting a guidewire into the guidewire lumen, the port joint having aproximal portion for attachment to a distal end of the proximal memberand a distal portion for attachment to a proximal end of the distalouter member and a proximal end of the distal inner member, wherein theproximal portion of the port joint is at least partially disposed withinthe distal end of the proximal member and the distal portion of the portjoint is at least partially disposed within at least one of the proximalend of the distal outer member or the proximal end of the distal innermember.
 12. The method of claim 11, wherein the step of molding the portjoint includes providing a structure adapted for attachment to thedistal inner member.
 13. The method of claim 11, wherein the step ofmolding the port joint includes providing a portion of the distal innermember within the mold and molding the port joint such that the distalinner member becomes attached to the port joint during the molding step.14. The method of claim 11, further comprising: providing a mandrelwithin the mold in which the port joint is molded prior to the step ofmolding; and removing the mandrel after the step of molding; wherein themandrel is placed within the mold to create an inflation passageway forconnecting the first inflation lumen to the second inflation lumen oncethe proximal member and the distal outer members are attached to theport joint.
 15. The method of claim 11, further comprising the steps of:providing a core wire passing through the mold into which the port jointis molded prior to the step of molding; and leaving at least a portionof the core wire in place after the step of molding to provide strainrelief across a joint from the proximal member to the distal innermember and distal outer member.
 16. The method of claim 11, furthercomprising: providing a void in the port joint for allowing a core wireto pass therethrough; providing a core wire through the void to providestrain relief to the port joint.
 17. A method of making a cathetershaft, the method comprising: providing a port joint having a proximalend and a distal end, the port joint including a guidewire port forreceiving a guidewire, and a lumen; providing a proximal tubular memberhaving a lumen; providing a first distal tubular member having a lumen;providing a second distal tubular member having a lumen; disposing thesecond distal tubular member within the lumen of the first distaltubular member; attaching the proximal tubular member to the proximalend of the port joint such that the lumen of the proximal tubular memberis in fluid communication with the lumen of the port joint, such that aportion of the proximal end of the port joint is at least partiallydisposed within the proximal tubular member; attaching the first distaltubular member to the distal end of the port joint such that the lumenof the first distal tubular member is in fluid communication with thelumen of the port joint, such that a portion of the distal end of theport joint is at least partially disposed within the first distaltubular member; and attaching the second distal tubular member to thedistal end of the port joint such that the lumen of the second distaltubular member is in fluid communication with the guidewire port of theport joint, such that a portion of the distal end of the port joint isat least partially disposed within the second distal tubular member;wherein the formed catheter shaft includes the proximal tubular member,the port joint, the first distal tubular member and the second distaltubular member.
 18. A method of making a catheter, the methodcomprising: providing a proximal tubular member of a catheter shaft, theproximal tubular member having a proximal end, a distal end and a lumenextending therethrough; providing a first distal tubular member of thecatheter shaft, the first distal tubular member having a proximal end, adistal end and a lumen extending therethrough; providing a second distaltubular member of the catheter shaft, the second distal tubular memberhaving a proximal end, a distal end and a lumen extending therethrough,wherein both of the first and second distal tubular members arestructurally distinct from the proximal tubular member; providing a portjoint for coupling the proximal tubular member of the catheter shaft tothe first and second distal tubular members of the catheter shaft, theport joint adapted to couple the lumen of the proximal tubular member tothe lumen of the first distal tubular member, the port joint including:a guidewire lumen disposed within the port joint for directing aguidewire into the lumen of the second distal tubular member, theguidewire lumen at least partially defined by an interior surface of theport joint; and a guidewire port for receiving a guidewire through anexterior wall of the port joint into the guidewire lumen; attaching theport joint to the distal end of the proximal tubular member of thecatheter shaft; and attaching the port joint to the proximal ends of thefirst and second distal tubular members of the catheter shaft; whereinthe port joint further includes a proximal portion and a distal portion,and the proximal portion is at least partially disposed within thedistal end of the proximal tubular member.
 19. A method of making acatheter, the method comprising: providing a proximal tubular member ofa catheter shaft, the proximal tubular member having a proximal end, adistal end and a lumen extending therethrough; providing a first distaltubular member of the catheter shaft, the first distal tubular memberhaving a proximal end, a distal end and a lumen extending therethrough;providing a second distal tubular member of the catheter shaft, thesecond distal tubular member having a proximal end, a distal end and alumen extending therethrough, wherein both of the first and seconddistal tubular members are structurally distinct from the proximaltubular member; providing a port joint for coupling the proximal tubularmember of the catheter shaft to the first and second distal tubularmembers of the catheter shaft, the port joint adapted to couple thelumen of the proximal tubular member to the lumen of the first distaltubular member, the port joint including: a guidewire lumen disposedwithin the port joint for directing a guidewire into the lumen of thesecond distal tubular member, the guidewire lumen at least partiallydefined by an interior surface of the port joint; and a guidewire portfor receiving a guidewire through an exterior wall of the port jointinto the guidewire lumen; attaching the port joint to the distal end ofthe proximal tubular member of the catheter shaft; and attaching theport joint to the proximal ends of the first and second distal tubularmembers of the catheter shaft; wherein the port joint further includes aproximal portion and a distal portion, and the proximal portion is atleast partially disposed within the distal end of the proximal memberand the distal portion is at least partially disposed within theproximal end of the first distal tubular member and the proximal end ofthe second distal tubular member.